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synonyms:
Periprosthetic Femur Fracture ICD-10
A- initial encounter
D- subsequent encounter
S- sequela
Periprosthetic Femur Fracture ICD-9
Periprosthetic Femur Fracture Etiology / Epidemiology / Natural History
- 996.41 mechanical loosening of prosthetic joint
- 996.44 peri-prosthetic fracture around prosthetic joint
- 996.45 periprosthetic osteolysis
Periprosthetic Femur Fracture Anatomy
Periprosthetic Femur Fracture Clinical Evaluation
Periprosthetic Femur Fracture Xray / Diagnositc Tests
- Consider ESR and CRP. 11% of periprosthetic fractures have concomitant infection. (Chevillotte CJ, Ali MH, Trousdale RT, Larson DR, Gullerud RE, Berry DJ. Inflammatory laboratory markers in periprosthetic hip fractures. J Arthroplasty. 2009 Aug;24(5):722-7)
Periprosthetic Femur Fracture Classification / Treatment
- Vancouver classification
- Type A=proximal to prosthesis (trochanteric region_:
- Type B1=fracture around the stem or at the tip of the stem with component solidly fixed.
-Treatment=plating vs allograft strut
- Type B2=femor fracture around or just distal to a loose stem with adequate proximal bone stock.
-Treatment= revision with long porous-coated cylindrical stem.
- Type B3=femor fracture around or just distal to a loose stem with poor proxmial bone
-Treatment: revision to long stem prosthesis +/- bone grafting/strutt. Consider proximal femoral replacement for elderly inactive patients. (Klein GR, JBJS 2005;87Am:1777).
- Type C=distal to prosthesis, treated independently
- Lateral locked plating with indirect reduction (Ricci WM, JOT 2006;20:190).
- Time to surgery for periprosthetic fracture >24 hours has higher rates of overall complications, urinary tract infections, non-home discharge, blood transfusions and longer length of stay. No statistical difference in mortality compared to ≤24 hours. (Boddapati V, J of Arthroplasty 2019)
- Age >70 with poor bone quality who require early mobilization = distal femur arthroplasty.
- Periprosthetic supracondylar femoral fractures: treatment options include conservative care, retrograde intramedullary femoral nail, locked or unlocked femoral plate, revision TKA.
Periprosthetic Femur Fracture Associated Injuries / Differential Diagnosis
Periprosthetic Femur Fracture Complications
Periprosthetic Femur Fracture Follow-up Care
Periprosthetic Femur Fracture Review References
- Duncan CP, ICL 1995;44:293
- Parvizi J, JBJS 2004;86A:8
- Younger AS, ICL 1998;74:251
- Lee SR, ICL 2004;53:111
- Ristevski B, Nauth A, Williams DS, Hall JA, Whelan DB, Bhandari M, Schemitsch EH. Systematic review of the treatment of periprosthetic distal femur fractures. J Orthop Trauma. 2014 May;28(5):307-12.
- Saidi K, Ben-Lulu O, Tsuji M, Safir O, Gross AE, Backstein D. Supracondylar periprosthetic fractures of the knee in the elderly patients: a comparison of treatment using allograft-implant composites, standard revision components, distal femoral replacement prosthesis. J Arthroplasty. 2014 Jan;29(1):110-4.
- Chen AF, Choi LE, Colman MW, Goodman MA, Crossett LS, Tarkin IS, McGough RL. Primary versus secondary distal femoral arthroplasty for treatment of total knee arthroplasty periprosthetic femur fractures. J Arthroplasty. 2013 Oct;28(9):1580-4.
- Thompson SM, Lindisfarne EA, Bradley N, Solan M. Periprosthetic supracondylar femoral fractures above a total knee replacement: compatibility guide for fixation with a retrograde intramedullary nail. J Arthroplasty. 2014 Aug;29(8):1639-41
- Service B, Kang W, Turnbull N, Langford J, Haidukewych G, Koval KJ. The Influence of Femoral Component Design on Retrograde Femoral Nail Starting Point. J Orthop Trauma. 2015 Apr 28.
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